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Upper Gastrointestinal Histopathological Findings in Children and Adolescents With Nonulcer Dyspepsia With Helicobacter pylori Infection

Carvalho, Mary Assis*; Machado, Nilton Carlos*; Ortolan, Erika Veruska Paiva; Rodrigues, Maria Aparecida Marchesan

Journal of Pediatric Gastroenterology & Nutrition: November 2012 - Volume 55 - Issue 5 - p 523–529
doi: 10.1097/MPG.0b013e3182618136
Original Articles: Gastroenterology

Objectives: The aim of the study was to investigate the histopathological lesions in the upper gastrointestinal mucosa associated with Helicobacter pylori infection in children with nonulcer dyspepsia.

Methods: A cross-sectional case-control study was performed on 185 Brazilian children and adolescents (4–17 years, mean 9.5 ± 2.7 years), 63.2% girls, submitted to upper gastrointestinal endoscopy. The histopathological lesions of the esophageal and gastric mucosa were analyzed in biopsy samples.

Results: H pylori infection was identified in 96 children (51.8%). Moderate to severe chronic active gastritis was present in antrum (70.5%) and corpus (45.2%), with higher grading in antrum than in corpus (P < 0.05). The topographic distribution of inflammation was pangastritis (61.9%), followed by antral (32.1%) and corpus (5.9%). H pylori density was higher in antrum than in corpus. Intestinal metaplasia was not found in the H pylori–infected group, nor was significant gastric atrophy. The scores for esophagitis were significantly higher (P < 0.05) in the noninfected group (1.4 ± 0.8) than in the H pylori–infected group (1.07 ± 0.9), with significant negative correlation (r = 0.29; P < 0.05) with the scores of gastric inflammation.

Conclusions: The prevalence of H pylori infection was high among children with dyspepsia and associated with moderate/severe degrees of gastric inflammation. The high scores of esophagitis in the noninfected group point to 2 distinct groups of pathological conditions sharing similar clinical patterns.

*Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics

Division of Pediatric Surgery, Department of Surgery

Department of Pathology, Botucatu Medical School, UNESP, Sao Paulo State University, Botucatu, SP, Brazil.

Address correspondence and reprint requests to Prof Maria Aparecida Marchesan Rodrigues, Department of Pathology, Botucatu Medical School, UNESP, Sao Paulo State University, Botucatu, SP CEP 18618-970, Brazil (e-mail: mariar@fmb.unesp.br).

Received 2 November, 2011

Accepted 10 May, 2012

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN